Fill and Sign the Law Agency Form

Agreement Between Informant and Police Department or Other Law Enforcement Agency Agreement made on the ________________ ( date) , between ____________________ (Name of Informant) of ________________________________________________________ ____________________ (street address, city, county, state, zip code) , referred to herein as Informant , and _________________________ (Name of Law Enforcement Agency) , of ____________________________________________________________________________ (street address, city, county, state, zip code) , a department of _________________ (Name of Municipality) , a local governmental subdivision in ___________________ (Name of state) . Said ______________________________ (Name of Law Enforcement Agency) is hereinafter referred to as the Police Department. For and in consideration of the mutual covenants contained in this Agreement, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties agree as follows: Informant hereby agrees:  I have no police power under the State of __________________ (Name) or any local governmental subdivision and have no authority to carry a weapon while performing my activity as an Informant.  I am associated with the ___________________ (Name) Police Department as an Informant on a case or time basis as an independent contractor and that any payment I receive from the __________________ (Name) Police Department will not be subject to Federal or State Income Tax Withholding or Social Security. All reporting of income is the responsibility of Informant.  I further acknowledge that as an Informant and independent contractor, I am not entitled to Workman's Compensation or Unemployment Compensation from the State of __________________ (Name) , and I shall not hold ______________________ (Name of Municipality) liable in any way for any injuries or damage incurred by reason of my association with the ____________________ (Name) Police Department.  I will not divulge to any person, except the investigator with whom I am associated, my status as an Informant for the __________________ (Name) Police Department. Police Department unless required to do so in court and shall not represent myself to others as an employee or representative of the Police Department.  I further agree not to use the _________________ (Name) Police Department or any of its officers as credit references or employment references unless prior approval is obtained from the investigator with whom I am associated.  My association with the __________________ (Name) Police Department does not afford me any special privileges.  After making a purchase of anything of evidentiary value, I will contact the investigator with whom I associated as soon as possible for delivery of such evidence to him.  I will maintain a strict accounting of all funds provided to me by the __________________ (Name) Police Department as part of my activity as an Informant.  I understand that misuse of county funds could be grounds for criminal prosecution against me.  Violation of any of the above enumerated provisions will be grounds for immediate termination and probable criminal charges. Witness our signatures, this the _________________ (date) . __________________________________ ______________________________________ Printed Name of Confidential Informant Printed Name of Chief of Police __________________________________ ______________________________________ Signature of Confidential Informant Signature of Chief of Police Badge Number: _______________________ ________________________________ ___________________________________ Printed Name of Witness Printed Name of Witness ________________________________ ___________________________________ Signature of Witness Signature of Witness